A patient came into Medicine Shoppe Pharmacy in Comox, B.C., to fill a prescription for a high-cost biologic. The man had PharmaCare and additional third-party drug coverage and had almost reached his deductible and family maximum. Pharmacist Wendy Stewart called the BC Pharmacy Association (BCPhA) pharmacy practice support team for billing clarification.
“I wanted to better understand the complexities of the third-party plans,” says Stewart. “And to back up our interpretations of what we could bill and mark up.”
BCPhA’s coordinator of pharmacy practice support Nelson Chen analyzed each of the payer’s policies and offered a written line-by-line breakdown explaining exactly how to process the claim.
“It was really beneficial and eliminated any questions in our mind,” says Stewart, who notes practice support is one of the top reasons she’s a BCPhA member. She feels it’s important others know the service is there.
Answering your practice questions The pharmacy practice support department at the BCPhA is dedicated to handling member inquiries around scope of practice, clinical services, training programs and public or private payer policies. Their job is to make life easier for busy, practicing pharmacists.
Stewart says some of the clarifications they receive from the BCPhA have helped simplify their workflow. For example, one of her coworkers, Greg Ouellette, recently reached out to BCPhA to clarify requirements around their custom software-generated medication review drug therapy problem (DTP) form. He received reassurance that patients did not need to sign the DTP form, although they do have to sign the best possible medication history (BPMH) form. He then passed along that information to all staff.
The team at Medicine Shoppe does a lot of medication reviews and injections thanks, in part, to a pharmacist dedicated to clinical services five days a week.
Four pharmacists are also in the process of achieving their geriatric certification to support the large senior population in the Comox Valley. It can be a lot to juggle for a busy pharmacy.
That’s why the extra support from the Association is helpful. Owner and pharmacy manager Catherine McCann says PharmaCare and third-party billing is the one area that has given her the most grief since she bought the Comox Medicine Shoppe two years ago.
“We work really hard to do it the right way,” McCann says. “But I do find that billing can be more difficult here in B.C.; there’s more coordination of benefits.”
“I really appreciate the collective wisdom of the Association regarding billing issues,” she says. “Even when I think I know what I’m doing, in the thick of the
day it’s easy to make a misstep when there are so many exceptions or special considerations.
“I’ve often asked for clarification. Just having someone to reflect the steps back to me is sometimes all I need.”
Chen, who is a regulated pharmacy technician, says that’s exactly what he’s there for. “I’m the first level of support,” he says. “If I can help you, I will, if not, I’ll
escalate it to pharmacists Ann Johnston or Derek Desrosiers.”
Saving time for busy pharmacists
The three-person team often acts as knowledge translators, interpreting College of Pharmacists of BC regulations or payer policies, and following up with
their resources and contacts to confirm. Then they provide concrete, written references to back them up.
“Regulations that are good for the patient should also be good for the profession,” McCann notes. “But sometimes policies can be ambiguous. It’s nice to be able to call a real, live voice for clarification.”
Chen adds that often the answers are available to pharmacists, but they might not know where to find it – and it takes time to do so.
Stewart agrees saving time is a big deal. “Whenever I call or email the responses are always very prompt and I find it really valuable,” she says. “And it absolutely saves us time.”
Expanded support for pharmacy members
While all members have access to this service, pharmacy – or corporate – members also receive detailed audit advice, as well as business support around buying a pharmacy, PharmaCare enrollment agreements or College requirements.
Venus Afshari, founder and owner of West Lonsdale Pharmacy in North Vancouver, says that she often requires clarification on PharmaCare dispensing fee billing, claim procedures and policy interpretations. Having it in writing from BCPhA's team means she can easily use the information as a reference point to share with her pharmacy manager and staff.
“Especially when it comes to audits, it’s not considered a mistake anymore – it’s considered fraud, so it’s a huge deal,” Afshari says. That support is the most significant benefit she finds in her corporate membership, with the policy and procedure manuals a close second.
“The BCPhA can be that advisor that has the pharmacy's owner and pharmacists' benefit in mind,” she says. “As a provider, that's a serious concern that I've found is non-existent, so it's great to have that.”
Elaine Akers is the vice-president of regulatory affairs for Medical Pharmacies Group Limited, which has three locations in B.C. Following a recent PharmaCare audit of their largest volume store, Akers reached out for audit assistance from BCPhA. Desrosiers met with her multiple times to review the audit and create a draft response. He also recommended a lawyer who was skilled with PharmaCare audits.
“It was very, very helpful knowing that you have the support and assistance, because every public payer likes you to respond in different ways,” says Akers.
She says she would definitely recommend other pharmacy members reach out if they need help.
“I’m sure every audit that occurs is a little different, so you get the benefit of having someone who has the experience and has looked at all these scenarios before.
Support with opening – and running – a pharmacy
The co-owner of two HealthPlus Pharmacies in Richmond, Mandeep Aulakh agrees that the service she receives is invaluable, particularly since she opened her second location four years ago.
"The Association was very helpful and readily available to answer any questions that we had and provide clarification where needed.
"There are many changes that have been happening in the pharmacy world; it is reassuring to be able to contact someone that is able to communicate this information to us," she adds.
To be proactive around audits, she checks in with the BCPhA team about anything else the pharmacists can incorporate into their practice. She’s also asked for a breakdown of policies, such as frequency of dispensing, for example.
“[The team] is always accommodating, and if they aren’t sure they find out. They send me something by email to prove it, so I have documentation that shows us how we should be doing something,” says Aulakh.
Aulakh says it saves her the time of having to go research herself. “It’s always good to have someone to be able to call on and get clarification. It’s great having someone on your side. This is the most important value I received from the BCPhA – it’s the biggest reason I’m a member, so I can call them up to ask for help.”